Background and Purpose:The Timed Up and Go (TUG) test is widely employed in the examination of elders, but definitive normative reference values are lacking. This meta-analysis provided such values by consolidating data from multiple studies.Methods:Studies reporting TUG times for apparently

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Reference values for the timed up and go test: a descriptive meta-analysis.

Background Impaired balance has a significant negative impact on mobility, functional independence, and fall risk in older adults. Although several, well-respected balance measures are currently in use, there is limited evidence regarding the most appropriate measure to assess change in community-dwelling older adults.

Objective The aim of this study was to compare floor and ceiling effects, sensitivity to change, and responsiveness across the following balance measures in community-dwelling elderly people with functional limitations: Berg Balance Scale (BBS), Performance-Oriented Mobility Assessment total scale (POMA-T), POMA balance subscale (POMA-B), and Dynamic Gait Index (DGI).

Design Retrospective data from a 16-week exercise trial were used. Secondary analyses were conducted on the total sample and by subgroups of baseline functional limitation or baseline balance scores.

Methods Participants were 111 community-dwelling older adults 65 years of age or older, with functional limitations. Sensitivity to change was assessed using effect size, standardized response mean, and paired t tests. Responsiveness was assessed using minimally important difference (MID) estimates.

Results No floor effects were noted. Ceiling effects were observed on all measures, including in people with moderate to severe functional limitations. The POMA-T, POMA-B, and DGI showed significantly larger ceiling effects compared with the BBS. All measures had low sensitivity to change in total sample analyses. Subgroup analyses revealed significantly better sensitivity to change in people with lower compared with higher baseline balance scores. Although both the total sample and lower baseline balance subgroups showed statistically significant improvement from baseline to 16 weeks on all measures, only the lower balance subgroup showed change scores that consistently exceeded corresponding MID estimates.

Limitations This study was limited to comparing 4 measures of balance, and anchor-based methods for assessing MID could not be reported.

Conclusions Important limitations, including ceiling effects and relatively low sensitivity to change and responsiveness, were noted across all balance measures, highlighting their limited utility across the full spectrum of the community-dwelling elderly population. New, more challenging measures are needed for better discrimination of balance ability in community-dwelling elderly people at higher functional levels.

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Sensitivity to Change and Responsiveness of Four Balance Measures for Community-Dwelling Older Adults

The invention provides systems and methods for neuromuscular electrical stimulation to muscle tissue. Stimulation electrodes and sensors may be provided, such that signals provided by the sensors may affect the signals provided to the stimulation electrodes, thus providing a feedback. Stimulation electrodes may be provided on a stimulation pad and sensors may be provided on a sensing pad, which may be designed to conform to an anatomical feature. A system for neuromuscular electrical stimulation may also include temperature sensitive elements that may help prevent burns, especially for comatose, sedated, or patients in critical condition. The system may also include a cooling assembly for a stimulation pad.

Systems and methods for automated muscle stimulation

Background: For allied health professionals wishing to assess the functional balance of older adults living in the community, the vast number of functional balance tests available makes it difficult to decide which assessment is most appropriate. Objective: To identify the reliability, concurrent validity and clinical practicality of functional balance tests with community dwelling older adults. Methods: A systematic review of published literature relevant to 17 functional balance tests was undertaken. The 17 functional balance tests were identified by a preliminary literature search and through consultation with an expert in the field of functional balance assessment. Studies published in English before January 2007, assessing the use of these functional balance tests with community dwelling adults aged 65 years or above were included. The CINAHL, MEDLINE, Ageline, Amed, PubMed, Cochrane library, PEDro and Joanna Briggs Institute databases were searched. The methodological quality of studies was assessed using a checklist criteria adapted from the Cochrane Working Group for Screening and Diagnostic Tests. Results: Eight databases were searched and 21 studies were included. The majority of studies demonstrated low to moderate methodological quality scores. Despite limitations reported for clinical application with community dwelling older adults, the Berg Balance Scale and the Timed Up and Go Test have been most rigorously tested. Reliability and concurrent validity of the Balance Screening Tool and the Fullerton Advanced Balance Scale had also been established in this population, however only one study was retrieved for each. Conclusion: The Berg Balance Scale and Timed Up and Go Test have published reliability and validity with community dwelling older adults. Further testing of other functional balance tests is required to establish their reliability and validity in this target population. BACKGROUND

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Functional Balance Assessment of Older Community Dwelling Adults: A Systematic Review of the Literature

The effect of the subcutaneous fat on the transfer of current through skin and into muscle.

Objective: To compare the Timed "Up and Go" and Functional Reach tests to the Berg Balance Scale for concurrent validity in a broad adult population. Design: A prospective study of individuals with balance deficits. Setting: Neurological rehabilitation, skilled nursing, and acute care facilities. Subjects: Twenty subjects: 12 females and eight males, aged 38 to 86 years (μ=68, SD=14.5). Intervention: The order in which the three tests were performed on each subject was randomized and the scores from the three tests were analyzed using correlation coefficients. Main Outcome Measures: Balance and correlations were based on scores from each of the three balance tests performed. Results: There was a significant correlation between the Berg Balance Scale and Timed "Up and Go" test (r=0.47, p=0.04) but no significant correlation between the Berg Balance Scale and the Functional Reach test (r=0.42, p=0.06). Pairing the Timed "Up and Go" and Functional Reach tests however, revealed a significant correlation (R=0.56, p=0.04). Conclusion: This study suggests that the Timed "Up and Go" test alone or a combination of the Timed "Up and Go" and Functional Reach tests can be used as a simple measure of balance comparable to the Berg Balance Scale.

Measurements of Balance: Comparison of the Timed "Up and Go" Test and Functional Reach Test with the Berg Balance Scale

Electrical stimulation of the quadriceps muscle was used to elicit 4-min isometric contractions at 10% of the maximal voluntary contraction (MVC) in four male and three female subjects. The effect of four waveforms, including Russian, interferential, sine, and square, on the mean stimulation current required to achieve the desired contraction force, subjective comfort, and physiological responses was studied. Interferential stimulation, even at full power, could not elicit a sustained contraction at 10% MVC. The contractions elicited by electrical stimulation utilizing the sine waveform required significantly less mean stimulation current to maintain the desired force of contraction with consistently lower verbal rating scale scores and greater increases in oxygen consumption than either the Russian or square waveform stimulations. Russian waveform stimulation produced a significantly greater rise in galvanic skin resistance than the sine or square waveform while the changes in respiratory quotient were similar between waveforms. The data support sine wave stimulation as working the best by producing the desired muscle tension with the least mean stimulation current and therefore, the least tissue trauma while providing the most subjective comfort.

Toward the optimal waveform for electrical stimulation of human muscle.

A new methodology is presented to simulate aircraft wake systems by decoupling the detailed high-lift wing geometry and the wake propagation through the implementation of an additional source term in the governing fluid transport equations. Initial high-fidelity CFD simulations are first computed, wherein the geometry of a medium-haul representative aircraft is altered to reflect changes in high-lift device deployment. A reduced-order-model (ROM) is then constructed from the CFD derived data to make realistic predictions of the spanwise loading between discrete high-lift deployment settings. Substitution of the spanwise loading is then performed on a per timestep basis to initialize the farfield wake simulation. The result of the farfield simulation showcased behavior mimicking the non-linear roll-up process, inherent in aircraft wake systems, without the need to simulate the parent geometry of interest or invoke traditional idealized vortex mathematical models. 

Scott D Bennie

Papers

Measurements of Balance: Comparison of the Timed "Up and Go" Test and Functional Reach Test with the Berg Balance Scale

Toward the optimal waveform for electrical stimulation of human muscle.

Data Driven Methodology for Decoupled Aircraft Wake Vortex Propagation Using Proper Orthogonal Decomposition